Attempt to improve the diagnosis of immune thrombocytopenia by combined use of two different platelet autoantibodies assays (PAIgG and MACE).
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BACKGROUND AND OBJECTIVES: Despite an extensive search for a definitive diagnostic assay for platelet autoantibodies, the laboratory diagnosis of immune thrombocytopenia (ITP) still remains a clinical challenge. Data in the literature have so far demonstrated that measurement of platelet-associated IgG (PAIgG) is sensitive, especially when flow cytometry is employed, but lacks adequate specificity. Measuring specific autoantibodies by antigen capture techniques increases specificity, but a large part of patients escape autoantibodies detection by such means too. The aim of the present study was to compare the diagnostic value of PAIgG with a modified antigen capture ELISA (MACE) in patients with primary and secondary immune thrombocytopenia and in patients with non-immune thrombocytopenia. DESIGN AND METHODS: One hundred and four patients with a platelet count lower than 100x109/L were studied. Forty-two patients had primary ITP (P-ITP), 23 patients had ITP secondary to other immune diseases (S-ITP) and 39 patients had thrombocytopenia due to decreased platelet production (non-immune; NITP). PAIgG was measured by immunofluorescent flow cytometry, whereas specific platelet-associated autoantibodies (against GP IIb/IIIa, Ib/IX, Ia/Ia) were measured by a commercially available modified antigen capture assay (MACE, GTI, USA). RESULTS: The sensitivity of the PAIgG assay for ITP was 60%, the specificity was 77%, the positive predictive value was 81% and the negative predictive value was 54%. The sensitivity of MACE was 60%, specificity was 97%, the positive predictive value 97% and the negative predictive value 59%. We found a 73% concordance between PAIgG and MACE assays. Both PAIgG and MACE had significantly greater sensitivity in S-ITP than in P-ITP. INTERPRETATION AND CONCLUSIONS: Forty percent of patients with clinically diagnosed immune thrombocytopenia had no detectable platelet autoantibodies, possibly because of intrinsic methodological detection problems, different stages of disease, or absence of a true immune etiology. (+info)
From Cuthbertson to fast-track surgery: 70 years of progress in reducing stress in surgical patients.
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OBJECTIVE: To evaluate the evolution of knowledge concerning the stress response in surgical patients and to determine the therapeutic benefit of stress reduction therapy. SUMMARY BACKGROUND DATA: The stress response in surgical patients is associated with tissue catabolism, organ failure, and prolonged recovery. Understanding the neural-hormonal basis for these events has stimulated efforts to attenuate these undesirable effects. A review of the results of these efforts is important for the application of stress reduction therapy and further improvement of surgical care. METHODS: Medline was searched from 1980 to the present using the terms "stress response," "neural-hormonal response," "fast track surgery," and "outcome in surgical patients." These papers were reviewed along with historical information relating to early descriptions of metabolic and stress responses in surgical patients. RESULTS: Improved understanding of the stress response in surgical patients has occurred over the past 70 years. Multiple examples of stress reduction associated with decreased morbidity and mortality are reported. CONCLUSIONS: Reduction of stress in surgical patients has improved outcome. The use of stress reduction techniques will continue to expand and contribute to the improvement of future surgical care. (+info)
Comparative analysis of baseline 8-oxo-7,8-dihydroguanine in mammalian cell DNA, by different methods in different laboratories: an approach to consensus.
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The European Standards Committee on Oxidative DNA Damage (ESCODD) was set up to resolve the problems associated with the measurement of background levels of oxidative DNA damage (in particular 8-oxo-7,8-dihydroguanine, or 8-oxoGua) in human cells. A tendency for DNA oxidation to occur during sample preparation prior to chromatography has been recognized as the source of a very substantial artefact. To assess the success of attempts to eliminate the artefact, ESCODD has distributed to its members standard samples of pig liver and HeLa cells for analysis. Estimates of 8-oxoGua in pig liver, using chromatographic techniques, ranged from 2.23 to 441 per 10(6) guanines, with a median of 10.47 per 10(6) guanines. Chromatographic analysis of HeLa cell DNA gave a range of 1.84 to 214 per 10(6) guanines with a median of 5.23 per 10(6) guanines. HeLa cell DNA was also analysed by an enzymic approach, in which whole cell DNA was treated with formamidopyrimidine DNA glycosylase, which nicks DNA at sites of 8-oxoGua, and the breaks measured with the comet assay, alkaline unwinding or alkaline elution. Values with these methods ranged from 0.06 to 4.988-oxoGua per 10(6) guanines, with a median of 0.79 per 10(6) guanines. Although there are clearly still serious discrepancies between methods and laboratories, the lowest estimates by chromatography (arguably those in which the artefact was best controlled) are only 2.5 times higher than the median value obtained with the enzymic approach. (+info)
Effect of Asian and Siberian ginseng on serum digoxin measurement by five digoxin immunoassays. Significant variation in digoxin-like immunoreactivity among commercial ginsengs.
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Asian and Siberian ginsengs contain glycosides with structural similarities to digoxin. We studied potential interference of ginseng in 5 digoxin immunoassays in 3 Asian (2 liquid extracts, 1 capsule) and 3 Siberian ginseng preparations (1 liquid extract, 2 capsules). With the fluorescence polarization immunoassay (FPIA), we observed apparent digoxin activity in 1 Asian liquid preparation and in the liquid extract and 1 capsule form of Siberian ginseng. In mice fed ginseng, we observed digoxin activities in the serum (Asian, 0.48-0.68 ng/mL [0.6-0.9 nmol/L]; Siberian, 0.20-0.47 ng/mL [0.3-0.6 nmol/L]), indicating that such interferences also occur in vivo. Serum pools prepared from samples from patients receiving digoxin and then supplemented with Asian or Siberian ginseng showed falsely increased digoxin values using the FPIA (e.g., for Asian ginseng, 1.54 ng/mL [2.0 nmol/L] vs control value, 1.10 ng/mL [1.4 nmol/L]) and falsely decreased values using the microparticle enzyme immunoassay (MEIA; 0.73 ng/mL [0.9 nmol/L] vs control value, 1.04 ng/mL [1.3 nmol/L]). Digoxin-like immunoreactive substances (DLISs) showed synergistic effects with ginsengs in interfering with the FPIA and MEIA for digoxin. No interference was observed with 3 other digoxin assays, even in the presence of elevated DLISs. (+info)
William Prout: early 19th century physician-chemist.
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In the early 19th century, the discoveries of new substances in the healthy and diseased body spawned a search for chemical explanations for physiologic phenomena to guide medical diagnosis and control therapy. William Prout's work on the nature and treatment of diseases of the urinary organs established his reputation as one of Britain's most distinguished physiological chemists. Prout was very skeptical of chemical remedies because of possible side effects, but he suggested iodine treatment for goiter. He emphasized that a satisfactory diet should include carbohydrates, fats, protein, and water. In 1824, he showed that the acid of the gastric juice was hydrochloric acid. Prout applied chemical methods and reasoning to physiology and was criticized for his view that the body's vital functions could be explained by chemistry. His remedy for lack of progress in animal chemistry was for physiologists to become chemists. Prout stimulated much discussion on atomic theory by his hypothesis that the atomic weights of all chemical elements are whole-number multiples of the atomic weight of hydrogen and that the chemical elements were condensed from hydrogen atoms. (+info)
Gene expression analysis of the acute phase response using a canine microarray.
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The safety of pharmaceuticals is typically assessed in the dog and rat prior to investigation in humans. As a result, a greater understanding of adverse effects in these preclinical testing species would improve safety assessment. Despite this need, there is a lack of tools to examine mechanisms and identify biomarkers in the dog. To address this issue, we developed an Affymetrix-based oligonucleotide microarray capable of monitoring the expression of thousands of canine genes in parallel. The custom canine array contains 22,774 probe sets, consisting of 13,729 canine and 9045 human-derived probe sets. To improve cross-species hybridization with human-derived probes, the detection region was moved from the variable 3' UTR to the more homologous coding region. Testing of this strategy was accomplished by comparing hybridization of naive dog liver RNA to the canine array (coding region design) and human U133A array (standard 3' design). Although raw signal intensity was greater with canine-specific probe sets, human-derived probes detected the expression of additional liver transcripts. To assess the ability of this tool to detect differential gene expression, the acute phase response was examined in beagle dogs given lipopolysaccharide (LPS). Hepatic gene expression 4 and 24 h post-LPS administration was compared to gene expression profiles of vehicle-treated dogs (n=3/group). Array data was consistent with an acute inflammatory response, with transcripts for multiple cytokines and acute phase proteins markedly induced 4 h after LPS challenge. Robust changes in the expression of transcripts involved with glucose homeostasis, biotransformation, and extracellular matrix remodeling were observed 24 h post-dose. In addition, the canine array identified several potential biomarkers of hepatic inflammation. Strong correlations were found between gene expression data and alterations in clinical chemistry parameters such as serum amyloid A (SAA), albumin, and alkaline phosphatase (ALP). In summary, this new genomic tool successfully detected basal canine gene expression and identified novel aspects of the acute phase response in dog that shed new light on mechanisms underlying inflammatory processes. (+info)
Transglycosidase activity of chitotriosidase: improved enzymatic assay for the human macrophage chitinase.
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Chitotriosidase is a chitinase that is massively expressed by lipid-laden tissue macrophages in man. Its enzymatic activity is markedly elevated in serum of patients suffering from lysosomal lipid storage disorders, sarcoidosis, thalassemia, and visceral Leishmaniasis. Monitoring of serum chitotriosidase activity in Gaucher disease patients during progression and therapeutic correction of their disease is useful to obtain insight in changes in body burden on pathological macrophages. However, accurate quantification of chitotriosidase levels by enzyme assay is complicated by apparent substrate inhibition, which prohibits the use of saturating substrate concentrations. We have therefore studied the catalytic features of chitotriosidase in more detail. It is demonstrated that the inhibition of enzyme activity at excess substrate concentration can be fully explained by transglycosylation of substrate molecules. The potential physiological consequences of the ability of chitotriosidase to hydrolyze as well as transglycosylate are discussed. The novel insight in transglycosidase activity of chitotriosidase has led to the design of a new substrate molecule, 4-methylumbelliferyl-(4-deoxy)chitobiose. With this substrate, which is no acceptor for transglycosylation, chitotriosidase shows normal Michaelis-Menten kinetics, resulting in major improvements in sensitivity and reproducibility of enzymatic activity measurements. The novel convenient chitotriosidase enzyme assay should facilitate the accurate monitoring of Gaucher disease patients receiving costly enzyme replacement therapy. (+info)
Clinical pathology for preclinical safety assessment: current global guidelines.
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Regulatory guidelines for preclinical safety assessment studies of new drugs, chemicals, and food additives exist in many large industrial countries. Current guidelines include recommendations or requirements for clinical pathology testing. Many of the testing requirements are similar for every country, but others are not. The similarities and differences among several of the guidelines are discussed, and specific instances of ambiguous or inappropriate testing requirements are cited. (+info)